| NPI | 1891920302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 47323) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 105015) |
| 207L00000X Anesthesiology (Licence: MN 53383) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2023-03-07 |